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Intro Into Healthcar
Medical Coding Professional: Intro to Healthcare
| Term | Definition |
|---|---|
| Continuum of care | Complete range of programs and services |
| Health Insurance Portability and Accountability Act (HIPAA) | Mandated administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information |
| Coding | Assigning numeric and alphanumeric codes to diagnoses, procedures, and services |
| For-profit hospital | Owned and managed by private entities or corporations and prioritize generating profits for shareholders or owners |
| Government-supported hospital | A non-profit hospital supported by local, regional, or federal taxes, and operated by local, state, or federal governments |
| Medicaid (Title 19) | Joint federal and state program that helps with medical costs for some people with low incomes and limited resources |
| Non-profit hospital | Does not make profits for owners of the hospital from the funds collected for patient services |
| Paleopathology | The study of human remains |
| Primary care | Services include preventive and acute care that are referred to as the first point of contact |
| Proprietary hospitals | For-profit hospitals owned by corporations, partnerships, or private foundations |
| Secondary care | The second level of healthcare services, provided by specialists after a patient has received initial care from their primary care provider |
| Tertiary care | The highest level of specialized medical care provided in hospitals or medical centers |
| Triage | An organized method of identifying and treating patients according to urgency of care required |
| Voluntary hospital | A non-profit hospital operated by religious or other voluntary groups |
| Abstracting | Data entry of codes and other pertinent information utilizing computer software |
| Electronic health record (EHR) | A digital collection of a patient's medical information that is stored and accessed electronically |
| Healthcare Common Procedure Coding System (HCPCS) | A standardized coding system used for medical billing and reimbursement to report procedures, services, and supplies |
| Current Procedural Terminology (CPT) | A standardized set of codes developed by the AMA to describe medical, surgical, and diagnostic services and procedures |
| International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) | A standardized set of codes used in the U.S. to collect information about diseases and injuries and to classify diagnoses and procedures |
| International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) | A U.S. based coding system used to code inpatient procedures |
| Teaching hospitals | Government, proprietary, or voluntary hospitals that are affiliated with a medical school |
| Obstetrics | The medical speciality that deals with preconception, pregnancy, childbirth, and postpartum |
| Otorhinolaryngology | The medical speciality that deals with diseases of the ears, nose, and throat |
| Thoracic Surgery | Surgical management of disease within the chest |
| Accreditation | Voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law |
| Bylaws | Rules that delineate medical staff responsibilities |
| Consulting | Label used to describe highly qualified practitioner who is available as a consultant when needed |
| Hospitalist | A physician who spends most of their time in a hospital setting admitting patients to inpatient services from local primary care providers |
| Medicare (Title 18) | Health program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease |
| Medical transcription | Accurate and timely transcription of dictated reports |
| What are public hospitals also called? | Government-supported hospitals |
| Quaternary care | Considered as an extension of tertiary care and includes advanced levels of medicine that are highly specialized, not widely used |
| Regulation | Interpretation of a law, written by a responsible regulatory agency |
| Standards | Measurements developed by an accreditation organization to evaluate a health care organization’s level of performance in specific areas |
| Universal chart order | Discharged patient record that is organized in the same order as when the patient was on the nursing floor |
| Medical genetics | A medical specialty that diagnoses and treats of patients with genetically linked diseases |
| Occupational therapy | A form of therapy for those recuperating from physical or mental illness that encourages rehabilitation through the performance of activities required in daily life |
| Cancer registrar | Collects cancer data from a variety of sources and reports cancer statistics to government and health care agencies, also called tumor registrar |
| Case manager | Responsible for coordinating patient care to ensure the appropriate utilization of resources, delivery of health care services, and timely discharge or transfer |
| Certified Documentation Improvement Practitioner (CDIP) | A medical or clinical practitioner who holds the CDIP credential and provides guidance on practices for clinical documentation of patient medical records |
| Certified Health Data Analyst (CHDA) | Credential validating an individual’s expertise in health data analysis |
| Certified Healthcare Technology Specialist (CHTS) | Credential validating an individual’s understanding of technologies and procedures relevant to information technology in the healthcare industry |
| Certified Professional in Health Informatics (CPHI) | AHIMA certification that validates an individual’s knowledge of expertise to support and utilize health informatics |
| Certified in Healthcare Privacy and Security (CHPS) | Credential validating an individual’s competency in health care data and information privacy and security issues |
| Chief Knowledge Officer (CKO) | Person who leads the development, management, and sharing of knowledge within an organization |
| Chief Information Officer (CIO) | Person responsible for the overall technological direction of an organization |
| Claims examiner | Reviews health-related claims to determine whether the costs are reasonable and medically necessary, based on the patient’s diagnosis |
| Clinical documentation improvement (CDI) program | Helps health care facilities comply with government programs and other initiatives with the goal of improving health care quality |
| Coding and reimbursement specialist | A healthcare expert who works in a medical clinic, doctor's office or hospital and helps classify patient information |
| Ethics | Judgements about what is right and wrong |
| Health information manager | Expert in managing patient health information and medical records, administering computer information systems, and coding diagnoses and procedures for health care services provided to patients |
| Health services manager | Plan, direct, coordinate, and supervise the delivery of health care; includes specialists who direct clinical departments or services and generalists who manage an entire facility or system |
| Medical assistant | A health care professional who works directly with doctors in medical offices and clinics, supporting various tasks related to patient care and administrative duties |
| Medical office administrator | Coordinates the communication, contract, data, financial, human resource, health information, insurance, marketing, and risk management operations of a provider’s office, also called a medical office manager |
| Professional practice experience | Externship or internship |
| Medical transcriptionist | Transcribes prerecorded dictation, creating medical reports, correspondence, and other administrative documents |
| Medical staff coordinator | Responsible for managing the medical staff office functions and assisting with physician credentialing process |
| Privacy officer | An individual designated by a healthcare organization to ensure compliance with privacy regulations, particularly HIPAA |
| Professional practice experience supervisor | Individual to whom the student reports while completing the professional practice experience at a health care facility |
| Reciprocity | Recognition of credentials by other entities |
| Risk manager | Responsible for gathering information and recommending settlements concerning professional and general liability incidents, claims, and lawsuits |
| Quality manager | Coordinates a health care facility’s quality improvement program to ensure quality patient care, improve patient outcomes, confirm accreditation/regulatory compliance, and prepare for surveys |
| Vendor salesperson | Manages a company’s sales for a given territory, provides information about available consulting services, and demonstrates products to potential customers |
| Accreditation Council for Graduate Medical Education (ACGME) | Professional organization responsible for accrediting medical training programs in the United States through a peer review process that is based on established standards and guidelines |
| Active | Medical staff member who delivers most hospital medical services and performs significant organizational and administrative medical staff duties |
| Agenda | Listing of all items of business to be discussed at a committee meeting |
| Board of governors | Membership serves without pay and is represented by psrofessionals from the business community; has ultimate legal authority and responsibility for the hospital’s operation and is responsible for the quality of care administered to patients |
| Board of trustees | Membership serves without pay and is represented by professionals from the business community; has ultimate legal authority and responsibility for the hospital’s operation and is responsible for the quality of care administered to patients |
| Associate | Medical staff member whose advancement to active category is being considered |
| Bylaws | Rules that delineate medical staff responsibilities |
| Centers for Medicare & Medicaid Services (CMS) | DHHS agency that administers Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) |
| Code of Federal Regulations (CFR) | Codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government |
| Chief resident | Position held by a physician in the final year of residency or in the year after the residency has been completed, plays a significant administrative or teaching role in guiding new residents |
| Healthcare Integrity and Protection Data Bank (HIPDB) | Created as part of HIPAA to combat fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioner’s, provider’s, or supplier’s past actions |
| Hippocratic Oath | Adopted as an expression of early medical ethics and reflected high ideals |
| HCPCS Level II (national) codes | Developed by the Centers for Medicare & Medicaid Services (CMS) and used to classify and report procedures and services |
| Deemed status | Hospitals that are accredited by approved accreditation organizations are determined to have met or exceeded Conditions of Participation to participate in the Medicare and Medicaid programs |
| Disaster recovery plan | Ensures an appropriate response to internal and external disasters that may affect hospital staff, patients, visitors, and the community |
| Courtesy | Medical staff member who admits an occasional patient to the hospital |
| Deeming authority | When an accrediting organization’s standards have met or exceeded CMS’s Conditions of Participation for Medicare certification |
| Health Plan Employer Data and Information Set (HEDIS) | A tool used by health plans to collect data about the quality of care and service they provide |
| Health Insurance Portability and Accountability Act (HIPAA) | Mandated administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information |
| Hippocrates | First physician to consider medicine a science and art separate from the practice of religion |
| Honorary | Retired medical staff member who is honored with emeritus status, also includes outstanding practitioners whom the medical staff wish to honor |
| Contract services | Arranging with outside agencies to perform certain functions, such as health information services, housekeeping, medical waste disposal, and clinical services |
| Health care proxy | Legal document (recognized by New York State) in which the patient chooses another person to make treatment decisions in the event the patient becomes incapable of making these decisions |
| Human Genome Project | Nationally coordinated effort to characterize all human genetic material by determining the complete sequence of the DNA in the human genome; in 2000, the human genome sequencing was published |
| Living will | Contains the patient’s instructions about the use of life-sustaining treatment |
| Merit-Based Incentive Payment System (MIPS) | Payment system established as a part the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law on April 16, 2015 that moves clinician Medicare Part B payment to a performance-based payment system |
| Physician Quality Reporting Initiative (PQRI) | The Tax Relief and Health Care Act of 2006 (TRHCA) authorized implementation to establish a financial incentive for eligible professionals who participate in a voluntary quality reporting program |
| Quality improvement organization (QIO) | New name for peer review organizations (PROs), QIOs continue to perform quality control and utilization review of health care furnished to Medicare beneficiaries |
| Record circulation | Includes the retrieval of patient records for the purpose of inpatient readmission, scheduled and unscheduled outpatient clinic visits, authorized quality management studies, and education and research |
| State department of health | Departments established by state governments to oversee health concerns within a state |
| State Children’s Health Insurance Program (SCHIP) | Health insurance program for infants, children, and teens that covers health care services such as doctor visits, prescription medicines, and hospitalizations |
| Critical access hospital | A hospital in a rural area that is located at least 35 miles from another hospital or another CAH |
| Ancillary services | Diagnostic and therapeutic services provided to inpatients and outpatients |
| Single hospital | Self contained and not part of a larger organization |
| Multi hospital systems | Two or more hospitals owned, managed, or leased by a single organization |
| Hospital bed count | The total number of beds a hospital or other healthcare facility has set up and staffed for inpatient use |
| Swing bed | Allows a rural hospital to admit a nonacute care patient |
| General hospital | A nonspecialized hospital, treating patients with all types of medical conditions |
| Specialty hospital | Focuses on a particular patient population or disease category |
| Rehabilitation hospital (inpatient) | Admits patients who are diagnosed with trauma or disease and need to learn how to function |
| Behavioral health care hospital | Specialize in treating individuals with mental health diagnoses |
| Ambulatory patients (outpatients) | Patients who are treated and released the same day and do not stay overnight in the hospital |
| Ambulatory surgery patients | Patients who undgero procedures that can be performed on an outpatient basis, with the patient treated and released the same day |
| Emergency care patients | Patients who are treated for urgent problems and either released the same day or admitted to the hospital as an inpatient |
| Inpatients | Patients who remain overnight in the facility for 24 or more hours and are provided with room and board and nursing services |
| Newborn patients | Patients who receive infant care upon birth |
| Observation patients | Patients who receive services furnished on a hospital’s premises that are ordered by a physician or other authorized individual |
| Subacute care | Provided in hospitals that provide specialized long-term acute care |
| Ambulatory care (outpatient care) | Outpatient care that allows patients to receive care in one day without the need for inpatient hospitalization |
| Skilled care | A high-level medical service requiring the expertise of licensed health professionals like nurses and therapists |
| Durable medical equipment (DME) | Equipment and supplies ordered by a health care provider for everyday or extended use |
| What does durable medical equipment include? | Canes, crutches, IV supplies, hospital beds, ostomy supplies, oxygen, prostheses, walkers, and wheelchairs |
| What does skilled care services include? | Assessment/monitoring of illnesses, IV and medication administration, insertion of catheters, tube feedings, and wound care |
| Drug therapy | Intravenous administration of other drugs |
| Hydration therapy | Intravenous administration of fluids, electrolytes, and other additives |
| Pain management | Intravenous administration of narcotics and other drugs designed to relieve pain |
| Total parenteral nutrition (TPN) | A method of feeding that provides a customized mixture of nutrients directly into a person's bloodstream through an intravenous (IV) line when the digestive system cannot be used |
| Palliative care | Specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness |
| Curative care | Medical treatment aimed at curing a disease, resolving an illness, or promoting a full recovery |
| Adult day care | Provides care and supervision in a structured environment to seniors with physical or mental limitations |
| Assisted-living facility (ALF) | Combination of housing and supportive services including personal care and household management for seniors |
| Continuing care retirement communities (CCRC) | Provides different levels of care based on the residents’ needs from independent living apartments to skilled nursing care in an affiliated nursing facility |
| Intermediate care facility (ICF) | A licensed residential setting that provides 24-hour supervision and more extensive medical care than assisted living, but less intensive than a hospital |
| Long-term care hospital (LTCH) | A hospital that has an average inpatient length of stay greater than 25 days |
| Residential care facility (RCF) | A place that provides 24-hour support and supervision for people who need help with daily activities |
| Skilled nursing facility (SNF) | A long-term care facility that provides 24-hour medical care and rehabilitation services for individuals who are recovering from an illness, injury, or surgery |
| Correctional facilities | Provide inmates with a secure housing environment that also offers vocational and educational advancement |
| Bureau of Prisons (BOP) | |
| Federal medical centers (FMCs) | Provide major medical care to federal correctional facility inmates |
| Military Health System (MHS) | |
| Military treatment facility (MTF) | Clinic and/or hospital located on a U.S. military base |
| Military Medical Support Office (MMSO) | Coordinates civilian health care services when military treatment facility (MTF) services are unavailable |
| Veterans Integrated Service Networks (VISN) | Administers and provides health care services at VA Medical Centers (VAMCs) and community-based outpatient clinics |
| Public Health Service (PHS) | A division of the Department of Health and Human Services (HHS) that protects and promotes public health through a wide range of programs and services |
| Respite care | Care is provided by specially trained individuals at a setting other than the patient’s home to offer relief and rest to primary caregivers |
| Theurapetic group home | 6 to 10 individuals are provided with supervised housing |
| Crisis service | Provides short-term (usually fewer than 15 days) crisis intervention and treatment |
| Ambulatory surgical center (ASC) | Surgery is performed on an outpatient basis at a freestanding ambulatory surgical center |
| Clinical labratory | Stand-alone clinical laboratory that performs testing in microbiology, clinical chemistry, and toxicology |
| Industrial health clinic | Located in a business setting, the emphasis is on employee health and safety |
| Single-specialty group physician practices | Two or more physicians who provide patients with one specific type of care |
| Multi-specialty group physician practices | Offer various types of medical specialty care in one organization, and they may be located in more than one location |
| Internal medicine physicians | Specialize in the care of adults |
| Family practioners | Provide care for the entire family and focus on general medicine, obstetrics, pediatrics, and geriatrics |
| Ambulatory surgery | Elective surgery is performed on patients who are admitted and discharged the same day, both general and local anesthesia are administered |
| Clinical outpatient | Hospital ambulatory care patient who receives scheduled diagnostic and therapeutic care |
| Referred outpatient | Hospital ambulatory care patient who receives diagnostic or therapeutic care because such care is unavailable in the primary care provider’s office |
| Satellite clinics | Ambulatory care centers that are established remotely from the hospital |
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